Validity of the Multiple Auditory Processing Assessment–2: A Test of Auditory Processing Disorder

Abstract

Purpose A normative study using the Multiple Auditory Processing Assessment–2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7–14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

Separating the Causes of Listening Difficulties in Children

“…If the words comprise one digit in each ear, the task is very easy for most people, so the score obtained is usually very close to 100% for both ears, making it hard to detect small asymmetries. To “sensitize” the test, the task is made more difficult by sequentially presenting two digits, or even three digits ( Moncrieff & Wilson 2009 ; Schow et al 2020 ) to each ear before asking the listener to freely recall all the digits presented to both ears, or just those for a selected ear. Unfortunately, such a change makes the test more dependent on short-term memory and also on attention.…”

Combination of Comorbidities as a Reference Standard for Evaluating Auditory Processing Disorder: Response to the Letter to the Editor From Schow et al. (2021)

“…There are concerns that reference standards used for most current tests evaluating developmental APD do not fulfill these requirements (Vermiglio, 2018). Schow et al (2020) defines their reference standard as APD identified formally by local professionals using different methods and techniques. In this instance, the reference standards and the norms of tests used by the different professionals lacked clarity, and the reliability and validity of such an approach is questionable.…”

“…In this instance, the reference standards and the norms of tests used by the different professionals lacked clarity, and the reliability and validity of such an approach is questionable. Schow et al (2020Schow et al ( , p. 1001) also considered the rationale of using comorbidity as a reference standard. The authors themselves expressed concerns that their method was not ideal.…”

“…The authors themselves expressed concerns that their method was not ideal. Schow et al (2020) wondered what an ideal reference standard would be and made an interesting comment that any method would lead to objection. Our opinion is that the use of appropriate combination of comorbidities using very definite cutoff criterion is a concrete, transparent, and replicable reference standard consistent with the STARD 2015 guidelines compared to Schow et al (2020).…”

“…The combination of AP tests and tools for comorbidities was considered at a second stage, from ASHA (2005, p. 10) considering significant functional difficulties and DeBonis (2015) considering failing one of two questionnaires (CCC2 [Bishop, 2003] and BRIEF [Gioia et al, 2000]), for diagnosing APD following only one AP test fail. Schow et al (2020) also used combination of APD tests plus a questionnaire but did not report the evidence for the cutoff they used. It also needs to be noted that all the tools assessing comorbidities in Ahmmed (2021a) were not questionnaires.…”